- Why are Thousands of Pharmacies Closing? (americanthinker.com)
I was unaware the loss of our drugstores was a nationwide trend until reading an article by Karen Kerrigan, president and CEO of the Small Business & Entrepreneurship Council. She reported that mom-and-pop drugstores in rural areas were particularly hard hit, leaving about 630 rural communities with no pharmacy by 2018. Kerrigan reported that the big chains closed nearly 2,000 pharmacies between 2017 and 2020 with more planned. CNN Business reported CVS will be closing another 900 stores in 2024. Walgreens and Rite Aid are also in the process of closing hundreds...Competition and the upsurge in shoplifting in soft-on-crime big cities are not the main causes. Kerrigan placed most of the blame on third-party Pharmacy Benefit Managers...READ MORE
- EmpiRx touts savings from value-based approach to behavioral health therapy management (fiercehealthcare.com)
EmpiRx Health saw a significant increase in pharmacy claims for behavioral health therapies but found managing these treatments in a value-based approach can mitigate the costs...The pharmacy benefit manager saw claims for behavioral health treatments grow 9.4% between 2020 and 2021...Utilization of antidepressant medications grew by 12% year over year, and use of treatments for attention-deficit/hyperactivity disorder increased by 20.2%...However, per claim spend for antidepressants declined by 1.8% between 2020 and 2021, and per claim spend for ADHD drugs decreased by 9.1%...“We published this data to shed light on this mental health tsunami as well as to demonstrate the successful outcomes of a financially aligned healthcare model," EmpiRx CEO Karthik Ganesh said...READ MORE
- Industry Voices—Integrating pharmacy into specialty practices improves access, care (fiercehealthcare.com)
Getting diagnosed with cancer or another life-altering illness can overwhelm patients, who suddenly face a complex condition while worrying about their future, family and finances. The ability to quickly access prescribed specialty medicines shouldn’t add to those worries...There’s a far more efficient way to handle this, both for patients and doctors: provide the prescribed medications at the cancer clinic or academic medical center where the patient regularly goes for testing and medical appointments. Embedding a specialty pharmacy within the practice—called medically integrated dispensing dramatically improves the healthcare experience by removing the PBM-controlled specialty pharmacy from the “triangle of care”—the doctor, the patient, and the pharmacist...READ MORE
- Exclusive: Five Pharmacy Chains and PBMs Dominate 2022’s Still-Booming 340B Contract Pharmacy Market (drugchannels.net)
Despite what you may have heard, pharmacy participation in the 340B Drug Pricing Program continues to thrive...Drug Channels Institute’s latest analysis reveals that an astonishing 32,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 2,000 locations...What’s more, five multi-billion-dollar, for-profit, publicly traded pharmacy chains and PBMs...account for three-quarters of all 340B contract pharmacy relationships with covered entities. Is this really what Congress intended when the 340B program was established in 1992?...The 340B Drug Pricing Program has become the second-largest government pharmaceutical program, based on net drug spending. But unlike such programs as Medicare Part D and Medicaid, 340B lacks a regulatory infrastructure, well-developed administrative controls, and clear legislation to guide the program...READ MORE
- PBM Formulary Exclusions List Reaches All-Time High (drugtopics.com)
The number of drugs excluded from the three largest pharmacy benefit manager formularies reached an all-time high in 2023, despite concerns that profits are being put ahead of patient access. This year, CVS Caremark, Optum Rx and Express Scripts — which together handle 80% of all prescriptions in the United States — each have roughly 600 medications on their standard formulary exclusion lists...Exclusions leave patients with fewer options for treatment unless they can afford the out-of-pocket costs of buying drugs that are not covered by the insurer. What is even more disturbing are the trends within the trend of formulary exclusions, critics say,,,READ MORE
- Cutting out the middleman, how Mark Cuban’s online pharmacy saves you money (cbsnews.com)Mark Cuban Cost Plus Drug Company announces first health plan partner, Capital Blue Cross (fiercehealthcare.com)
Who decides how much you pay for prescription medicines? It's a question with a very complicated answer. Now, Mavericks owner Mark Cuban is hoping to simplify the process and save you money by opening his own pharmacy...Cuban helped launch Cost Plus Drugs in January. It's an online pharmacy with no storefronts that offers more than 1,000 generic drugs. The business model is built on transparency. Each drug profile breaks down how Cost Plus determines its price: cost plus a 15% markup, $3 pharmacy fee, and $5 for shipping..."We get people coming to us and saying 'your price is $10, my co-pay is $20,'" said Cuban. "'So I'm ignoring my insurance and coming straight to you.'"...Cost Plus does it by negotiating directly with drug manufacturers and cutting out the middleman...READ MORE
- Drug price controls would limit new medicines (washingtonexaminer.com)Reducing Patient Access to New Medications: Progressives Latest Medicare Price Fixing Scheme (realclearhealth.com)
...Republican and Democratic senators met with the chamber's parliamentarian to discuss whether the bill's proposal for Medicare to negotiate the price of prescription drugs with manufacturers has a direct impact on government spending or tax revenue, as reconciliation rules require...But these are not negotiations. They're price controls. The bill's text sets maximum prices that the government will pay — and threatens confiscatory taxes for drug companies that refuse to comply...it will mean that fewer cutting-edge drugs are available to American patients...price controls on prescription drugs are unnecessary. Even as the price of just about everything else in our economy has soared in the past year, drug prices have been relatively flat...If lawmakers want to reduce patient drug costs meaningfully, they should train their focus on pharmacy benefit managers...PBMs keep a cut of the savings they extract and send another cut to the insurer, which may use that cut to lower overall premiums...READ MORE
- States Move to Ban Accumulators (drugtopics.com)The State of Employers’ Pharmacy Benefits: A Review of 2022 and the 2023 Outlook for Copay Programs (drugchannels.net)How Copay Accumulators and Maximizers Have Changed Payers’ View of Copay Support (drugchannels.net)
Sixteen states have banned a pharmacy benefit management practice that involves not counting the value of drug copay assistance from manufacturers toward patient deductibles...Drugmakers use copay assistance programs to shield patients from out-of-pocket expenses — and build market share for their products in the process. But pharmacy benefit managers have cried foul, saying the copay programs undercut formularies and wind up increasing the use of expensive drugs that are not any better than less expensive ones. They have pushed back with “copay adjustment programs,” especially “copay accumulators,” which are designed to blunt the effect of the copay assistance programs by not counting their value toward patient deductibles...READ MORE
- The Pharmacy Benefit Manager scam (americanthinker.com)
When I served as a White House health advisor, I invited a group of large employers to describe the challenges company health plans faced. The top complaint? An obscure type of middleman that’s part of every health plan -- the Pharmacy Benefit Manager. The PBM industry, with only three giant companies controlling almost 80 percent of the market, offers a seemingly simple value proposition: if you’re an employer or an insurance carrier serving individuals or businesses, hire the PBM to help you get volume discounts on prescription drug makers...Sounds great! But, what if these middlemen pocketed much of the savings instead of passing them on to employers?...READ MORE
- It’s time to expose the secret drug scam at the heart of American health care (finance.yahoo.com)
A federal court recently exposed the rot at the heart of America's healthcare system...The case, filed in the U.S. District Court for the District of Columbia, partly revolved around the many low-income, and even middle-income, patients who receive "co-pay coupons" from drug manufacturers to help them cover their out-of-pocket costs at pharmacies...For many Americans, these coupons represent the difference between filling a prescription and going without lifesaving care. But in recent years, health insurers have started to effectively steal those coupons, leaving patients on the hook for far higher expenses. As Judge Carl Nichols noted in a May ruling, insurance companies "pocket for themselves at least some of the assistance."...Sadly, the practice is totally legal. And until lawmakers crack down on this sort of grossly immoral behavior, insurance behemoths and their allies will continue shifting costs onto patients, with disastrous consequences for individuals' health and society at large...READ MORE